Peritoneal Cancers and Hyperthermic Intraperitoneal Chemotherapy

Our plain-English summary of Peritoneal Cancers and Hyperthermic Intraperitoneal Chemotherapy, by E. Pletcher, E. Gleeson, D. Labow (The Surgical Clinics of North America, 2020).

The study

• Authors: E. Pletcher, E. Gleeson, D. Labow
• Journal: The Surgical Clinics of North America
• Published: 2020;100(3):589-613
• Type of article: Review
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy is an aggressive, potentially curative approach used to treat locoregional disease associated with primary and secondary malignancies of the peritoneum. It involves resection of all macroscopic disease larger than 2.5 mm, followed by instillation of hyperthermic chemotherapy directly into the peritoneum for higher drug exposure to microscopic disease. In select patients with primary peritoneal mesothelioma, pseudomyxoma peritonei, colorectal adenocarcinoma, appendiceal adenocarcinoma, or ovarian cancer, with no extra-abdominal metastasis and limited involvement of the peritoneum, the procedure can be performed to increase overall survival.

Copyright © 2020 Elsevier Inc. All rights reserved.

In plain English

This article is a narrative review, not a new study. The authors, surgeons at Mount Sinai in New York, described cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC). In this treatment, surgeons remove visible tumor from the abdominal lining and then bathe the abdomen in heated chemotherapy. The review covered primary peritoneal mesothelioma, pseudomyxoma peritonei, and colorectal, appendiceal and ovarian cancers. The article did not study asbestos. It noted that men in the United States develop mesothelioma more often, possibly because of work-related asbestos exposure, which it called the most well-known cause. Citing earlier research, it said the peritoneum is the second most common site of mesothelioma after the pleura. Crediting Alexander and colleagues, it reported a median overall survival of 38.4 months after complete or near-complete resection with heated intraperitoneal cisplatin. It contrasted this with 6 months with systemic chemotherapy alone, a figure cited to a separate source. The authors described their own institution's technique, which uses mitomycin for peritoneal mesothelioma. They concluded that these cancers can be treated this way with curative intent, and that patient selection and survival depend on the amount of tumor in the abdomen.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of the literature on peritoneal cancers and cytoreductive surgery with HIPEC, including a description of the authors' institutional operative technique
• Who was studied: No study population of its own. The article reviews published work on patients with primary peritoneal mesothelioma, pseudomyxoma peritonei, and colorectal, appendiceal and ovarian cancers involving the peritoneum.
• Exposure: Asbestos exposure was not studied. The article mentions work-related asbestos exposure as a possible reason for the higher rate of mesothelioma in US men, calling asbestos the most well-known cause. The treatment reviewed is cytoreductive surgery with heated intraperitoneal chemotherapy.
• Main results:
  • Citing other sources, the review states that the peritoneum is the second most common site of mesothelioma after the pleura, making up 7% to 18% of reported cases, with an incidence of 1 case per 100,000 people
  • The review notes there is no American Joint Committee on Cancer TNM staging system for malignant peritoneal mesothelioma
  • Citing Alexander and colleagues, the review reports a median overall survival of 38.4 months after complete or near-complete resection and heated intraperitoneal chemotherapy with cisplatin in peritoneal mesothelioma. It contrasts this with 6 months median survival with systemic chemotherapy alone, a figure attributed to a separate reference (reference 10).
  • Citing other studies, the review states that 30% to 50% of patients presenting with peritoneal mesothelioma report abdominal pain and distension
  • For pseudomyxoma peritonei and peritoneal mesothelioma, the review states there is no established peritoneal cancer index threshold at which surgery and HIPEC are contraindicated
  • The authors' institution uses mitomycin for peritoneal mesothelioma: 17.5 mg/m2 followed by 8.8 mg/m2 every 30 minutes, at a goal outflow temperature of 42 Celsius, with a 70 mg maximum total dose
  • The review states that HIPEC for palliation of symptomatic ascites was first introduced by Ma and colleagues for primary peritoneal mesothelioma
• The authors' conclusion: The authors concluded that peritoneal mesothelioma, and peritoneal metastasis from colorectal, appendiceal, ovarian cancer and pseudomyxoma peritonei, can be treated with cytoreductive surgery and HIPEC with curative intent. They concluded that patient selection and overall survival depend on the peritoneal cancer index.

Topics

Medical terms in this study, explained in our Lexicon: HIPEC, Cytoreductive Surgery, Peritoneum, Chemotherapy, Peritoneal Mesothelioma, Adenocarcinoma, Ovarian Cancer, Metastasis.

Related studies

• Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC) — M. Desantis, J.L. Bernard, et al. (2015)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia — A. Galan, P. Rousset, et al. (2018)
• Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability — P.F. Bagnoli, F.C. Cananzi, et al. (2015)
• The Role of Hyperthermic Intraperitoneal Chemotherapy for Non-colorectal Peritoneal Surface Malignancies — M.C. Morris, J.M. Cloyd, et al. (2021)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)

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